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HomeMy WebLinkAboutElevation Certificate - BLD Letters / Memos - 1/29/2013 U.S.DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY ELEVATION CERTIFICATE OMB No. 1660-0008 National Flood Insurance Program IMPORTANT:I ollow the instructions on pages 1-9. Expiration Date: July 31, 2015 SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Alan & Debra Griswold Policy Number A2. Buildin Street Address(including Apt.,Unit,Suite,and/or Bldg. No.)or PO. Route and Box No. Company NAIL Number: 76 NE Emerald Glen Lane city Belfair State WA ZIP Code 98528 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) J Parcel 1 of Boundary Line Adjustment No. 93-016 Mason County Parcel No. 12316-50-00002 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)BeSi!d_ential __ A5. Latitude/Longitude:Lat._471 99'99 6" Long. 122°48'51 6" Horizontal Datum: ❑NAD 1927 ❑x NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 9 A8. For a building with a crawlspace or enclosure(s): A9.For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 1,768 sq ft a) Square footage of attached garage 441 sq ft b) No.of permanent flood openings in the crawlspace or 11 b) Number of permanent flood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade 9 c) Total net area of flood openings in A8.b 924 sq in c) Total net area of flood openings in A9.b O sq in d) Engineered flood openings? ❑Yes ❑X No d) Engineered flood openings? ❑Yes ©No SECTION B—FLOOD INSURANCE RATE MAP(FIRM) INFORMATION B1. NF1P Community Name&Community Number B2.County Name B3.State Mason County 530115 Mason Coun Uninco rated Area WA B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel Effective/ B8.Flood Zone(s) B9.Base Flood Elevation(s)(Zone Revised Date AO,use base flood depth) 5301150070 C 05/17/1988 05/17/1988 A2 101.5' B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9: ❑FIS Profile ❑x FIRM ❑Community Determined ❑Other/Source: B11.Indicate elevation datum used for BFE in Item B9: Q NGVD 1929 ❑NAVD 1988 ❑Other/Source: _ B12.Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ❑X No Designation Date:_ / / ❑CBRS ❑OPA SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑Construction Drawings* ❑Building Under Construction* ❑X Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO.Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only,enter meters. Benchmark Utilized: WSDOT#6642(Daley) Vertical Datum: NGVD 29 Converted Indicate elevation datum used for the elevations in items a)through h)below. ©NGVD 1929 ❑NAVD 1988 ❑Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor) 101 . 75 X❑feet ❑meters b) Top of the next higher floor 105 04 ❑X feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) _. ❑feet ❑meters d) Attached garage(top of slab) 103 _ 75 Q feet ❑meters e) Lowest elevation of machinery or equipment servicing the building 103 .7_9 Q feet ❑meters (Describe type of equipment and location in Comments) 0 Lowest adjacent(finished)grade next to building(LAG) 103 08 ❑X feet ❑meters g) Highest adjacent(finished)grade next to building(HAG) 104 73 Q feet ❑meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including _ 103 19 ®feet ❑meters structural support SECTION D—SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. [fl Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a L-A MC� Check here if attachments. licensed land surveyor? ©Yes ❑No Certifier's Name License l°j Michael McEvill _ 44639 Number Title Company Name o Survey Manager Sitts&Hill Engineers Address — City State ZIP Code c�S's. EGrsTER�'�.J�, 4815 Center Street Tacoma WA 98409 f0�'A1 LA2�s Signature ' / Date Telephone (253)474-9949 FEMA Form 086-0-33(7/12) See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE,page 2 IMPORTANT:In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or PO-Route and Box No. Policy Number: 70 NE Emerald Glen Lane city State ZIP Code Company NAIC Number: Belfair WA 98528 SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. Comments Conversion of Washington Dept.of Transportation(WSDOT)benchmark#6642(Daley)from NAVD 88(90.367')to NGVD 29(86.857')done by US Army Corps of Engineers conversion software Corpscon v6.0.1 Lowest mechanical is water heater sitting on floor of garage. Signature Date -V /���( w i z9/Zoe 3 SECTION E—BUILDING ELEVAT(O INFORMATION(SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items E1-E5.If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,and C. For Items El-E4,use natural grade,if available.Check the measurement used.In Puerto Rico only,enter meters. E1.Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or ❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or ❑below the LAG. E2.For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions), the next higher floor(elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG. E3.Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG. E4.Top of platform of machinery and/or equipment servicing the building is _ ❑feet ❑meters ❑above or ❑below the HAG. E5.Zone AO only:If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance?❑Yes ❑No ❑Unknown.The local official must certify this information in Section G. SECTION F—PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or communityissued BFE)or Zone AO must sign here.The statements in Sections A,B,and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑Check here if attachments. SECTION G—COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certificate.Complete the applicable item(s)and sign below.Check the measurement used in Items GS-G10.In Puerto Rico only,enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation information.(Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or communityAssued BFE)or Zone AO. G3. ❑ The following information(Items G4-G9)is provided for community floodplain management purposes. G4. Permit Number G5.Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑New Construction ❑Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum G10.Community's design flood elevation: ❑feet ❑meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments. FEMA Form 086-0-33(1/12) RPnl--Al nr-A--—iti— J ' ELEVATION CERTIFICATE, page 3 BUILDING PHOTOGRAPHS See Instructions for Item A6. IMPORTANT:In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg. No.)or PO. Route and Box No. Policy Number: 70 NE Emerald Glen Lane City State ZIP Code Company NAIC Number: Belfair WA 98528 If using the Elevation Certificate to obtain NFIP flood insurance,affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents,as indicated in Section A8. If submitting more photographs than will fit on this page,use the Continuation Page. I �Y\ - ®_ i Front-Taken 1-24-13 I'Iilllllllihll�Iil .a _. 11-�` _ — --- _.•-+--+^--..,. - ,- yam..:_.. • VN Back -Taken 1-24-13 FEMA Form 086-0-33(7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 BUILDING PHOTOGRAPHS Continuation Page IMPORTANT:In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg. No.)or PO. Route and Box No. Policy Number: 70 NE Emerald Glen Lane City State ZIP Code Company NAIC Number: Belfair WA 98528 If submitting more photographs than will fit on the preceding page,affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and,if required,"Right Side View" and "Left Side View."When applicable,photographs must show the foundation with representative examples of the flood openings or vents,as indicated in Section A8. ,.a _ I T Left Side - Taken 1-24-13 Via —41 s ; .: '� y `-�'^ ' ♦ L._ `, S.R.. .a Right Side -Taken 1-24-13 FEMA Form 086-0-33(7/12) Replaces all previous editions.